| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | 1800 QUAIL ST SUITE 110 NEWPORT BEACH, CA 92660 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $11K | — | $11K | 9.93% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS SVCS | 1800 QUAIL ST SUITE 110 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 3.05% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS SVCS | 1800 QUAIL ST SUITE 110 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $966 | $966 | 3.02% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS SVCS | 1800 QUAIL ST SUITE 110 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $905 | $905 | 2.98% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | 1800 QUAIL ST SUITE 110 NEWPORT BEACH, CA 92660 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 14.80% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BLVD STE 200 HAUPPAUGE, NY 11788 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $474 | $474 | 4.93% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BLVD STE 200 HAUPPAUGE, NY 11788 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $139 | $139 | 1.45% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $590 | — | $590 | 10.00% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS SVCS | 1800 QUAIL ST SUITE 110 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $175 | $175 | 2.97% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 100 | $113K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 100 | $113K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 141 | $30K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 103 | $34K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 100 | $32K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 141 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 141 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.